Reference for Candidate Reference for Candidate Thank you for taking the time to complete this reference. This is an important part of the due diligence effort for our clients.Name*Cell Phone*Administrators & Physicians may follow up to discuss the candidate. Title*MD/DO, CEO, CMO, etcEmail* Specialty and/or roleInternist, Psychiatrist, etc.Work PhoneThis reference is for?*How long have you known the provider?*What is your relationship to the provider?*For the questions below, please use the following scale: 1 = very poor, 10 = excellent(As a guide our clients recognize the following rating system: Below average 1-6, Average 7, Good 8, Very Good 9, and Excellent 10.)On a scale of 1 to 10, how would you rate the candidate's CLINICAL JUDGEMENT?*12345678910Supporting or additional commentsOn a scale of 1 to 10, how would you rate the candidate's CLINICAL KNOWLEDGE?*12345678910Supporting or additional commentsOn a scale of 1 to 10, how would you rate the candidate's COMMUNICATION SKILLS?*12345678910Supporting or additional commentsOn a scale of 1 to 10, how would your rate the candidate's PERSONALITY/REPUTATION?*12345678910Supporting or additional commentsOn a scale of 1 to 10, how would your rate the candidate's BEDSIDE MANNER?*12345678910Supporting or additional commentsOn a scale of 1 to 10, how would you rate the candidate's WORK ETHIC?*12345678910Supporting or additional commentsOn a scale of 1 to 10, how would you rate the candidate's LEADERSHIP/MANAGEMENT?*12345678910Supporting or additional commentsOn a scale of 1 to 10, how would your rate the candidate's ability to ADAPT TO NEW SITUATIONS/HANDLE STRESS?*12345678910Supporting or additional commentsOn a scale of 1 to 10, how likely would you be to HIRE THIS CANDIDATE?*12345678910Supporting or additional commentsIn your own words, what ADDITIONAL COMMENTS would you like to include?*On occasion, the hiring physician or administrator may follow up via a phone call. When are the best days and times that you can be reached for a follow up?*
